Journal of pediatric nephrology
Volume:10 Issue: 4, Autumn 2022

The etiology of hematuria in children is different. Hematuria is a known risk factor for developing chronic kidney disease (CKD). This narrative review aimed to evaluate the etiology of hematuria in children, mainly new hematuria research, to provide an update on the management, and complications that can improve the prognosis of hematuria.

For this narrative review, articles from several sources, including Scopus, Google Scholar, Embase, Web of Science, PubMed, and the Directory of Open Access Journals were used.

Kidney and urinary tract infection (UTI) is the most common cause of hematuria in children. Renal structural abnormalities, hypercalciuria, urinary stones, and extrarenal abnormalities associated with hematuria.

Hematuria is a symptom and very dangerous, but due to various causes in these patients, it is needed in all patients. The challenge for pediatric nephrologists is the early diagnosis of children with progressive forms of kidney disease from other causes. This manuscript reviews the multiple potential causes of microscopic hematuria and provides a framework for the initial assessment and monitoring of such patients. No internationally accepted, uniform, evidence-based algorithm exists for its diagnostic evaluation anywhere. It is recommended that extensive public attention be paid to the etiology and management of hematuria.

Acute post-infectious glomerulonephritis (PIGN) can occur due to various etiologies. Among these, post-streptococcal glomerulonephritis is the common cause. Though the burden has drastically decreased over the years in developed nations, it remains a reason for concern in developing countries. This study aimed to document the burden, clinical presentation, etiology, and outcome of PIGN referred to a tertiary care center in a developing country.

This retrospective study was conducted in a tertiary care teaching hospital in northeast India. All cases diagnosed with acute PIGN were included in the study. Cases with an alternate diagnosis and cases with incomplete records were excluded from the study. Data on relevant clinical, demographic, and laboratory variables were extracted from the case records and discharge summary. Simple descriptive statistics, such as frequency and proportion were used.

A total of 202 cases of PIGN were included in the study. The Mean±SD annual admission rate was 22.4±6.1 per year. The Mean±SD age at presentation was 10.0±3.9 years and the male to female ratio was 1.2 to 1. The most common clinical features at the time of presentation were hypertension in 183 patients (90.59%), edema in 168 (83.16%), history of oliguria in 146(72.27%), and hematuria in 168 patients (83.2%). Proteinuria was present in 95 cases (47.03%). Either clinical or serological evidence of preceding streptococcal infection was observed in 160 children (83.2 %). Two cases had scrub typhus and one case had hepatitis B seropositivity. Hypertensive encephalopathy and left ventricular failure were observed in 20(9.90%) and 44 children (21.78%), respectively. Admission to the pediatric intensive care unit was required in 28.21%. No mortality was observed.

PIGN constitutes a significant burden in this part of India. The incidence of complications was high but the outcome was good with adequate acute care.

Chronic kidney disease (CKD) is often associated with a variety of cognitive deficits. This will have significant lifelong implications. Therefore, we measure the clinical predictors of cognitive impairment.

This cross-sectional study was conducted in a third-level hospital from October 2017 to December 2018. A total of 41 patients with CKD stage III to V and V on dialysis, aged 6 to 14 years of both sexes were included in this study. CKD was staged according to the estimated glomerular filtration rate (eGFR). The Wechsler intelligence scales for childrenrevised (WISC-R) were provided as an individualized measure of verbal and performance abilities. Then individual score was compared among the study population.

A total of 41 patients were studied. The Mean±SD age was 10.35±2.19 years. The majority were male (56%) and the male-to-female ratio was 1.3:1. Full-scale intelligence quotient (IQ) deficits were found in 31 patients (75.6%) and most of them had mild cognitive deficits (96.8%). Among them, verbal IQ deficit was found in 7 patients (17.1%), performance IQ deficit in 6(14.6%), and combined IQ deficit in 18(43.9%). IQ score did not depend on the severity of the disease. The duration of the disease was longer and the age at initiation of renal replacement therapy (RRT) was lower, for those with the cognitive deficit, was not significant. School attendance and performance were significantly poor in cognitive deficit patients but anemia and hypertension had no significant impact.

The mild cognitive deficit was often associated with childhood CKD but not related to the severity of the disease. Therefore, the cognitive function should be routinely screened and monitored during the evaluation of children with CKD.

The present study aimed to evaluate the frequency and risk factors of peritonitis end-stage renal disease (ESRD) pediatrics on peritoneal dialysis (PD) in Yazd City, Iran.

This cross-sectional study was conducted on ESRD pediatrics on PD in Shahid Sadoughi hospital, Yazd City, Iran from 2016 to 2020. Demographic characteristics, such as age, sex, body mass index (BMI) at the commencement of PD, underlying medical conditions, the microbiology of peritonitis, and the recovery rate were investigated. Results were evaluated using SPSS software, version 26 (SPSS Institute, Inc., Chicago, IL, USA).

A total of 23 children (56.5% females) were included in this study. The Mean±SD age was 13.30±4.38 years, and the mean BMI was 15.71±5.53. PD-associated peritonitis was diagnosed in 18 cases (78.3%). A total of 21.7% had at least one underlying disease. No significant relationship was observed between sex (P=0.9), mean age (P=0.41), mean BMI (P=0.24), and underlying condition (P=0.29) according to pediatrics with and without PDassociated peritonitis. Bacterial and fungal infections were responsible for peritonitis in 15 (62.5%) and 3 (13%) pediatrics on PD, respectively.

The frequency of PD-associated peritonitis in the ESRD children of our study was 78.3%.

Urinary tract infection (UTI), is a common bacterial infection in pediatric group, can be easily diagnosed, but its recurrence can indicate underlying serious anatomical defects of the urogenital tract, leading to acute morbidity and chronic medical condition, such as hypertension and renal insufficiency.

To know the clinical spectrum and the frequency of recurrent UTI among children visiting our hospital.

This prospective study was conducted during the period from April 2020 to March 2021, in the department of pediatrics and pediatric nephrology, Governmental Medical College, Srinagar. All children aged between 6 months to 18 years presenting with a history of recurrent urinary tract were included in the study. A detailed history, relevant clinical examination, and the ultrasonography of kidney ureters and bladder (USG KUB) followed by voiding cystourethrography (VCUG), were carried out and subsequently analyzed.

A total of 38 patients with recurrent UTI were evaluated during one year. The commonest age group was 6 months to 2 years (68%), with female preponderance (F: M 3.2:1). Urine culture grew E. coli in 95% of patients, while USG abnormalities and the presence of vesicoureteral reflux (VUR) on voiding cystourethrography (VCUG) were seen in 14 patients (36%).

Recurrent UTI are common between 6 months to 2 years, and E coli is the most common cause. Children with the past history of UTI seem more predisposed to have another E.coli-associated UTI.

Acute kidney injury (AKI) is an acute decline in function and inability to regulate acid, electrolyte, and fluid balance. AKI can be classified as community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI) depending on the time of onset. Most studies have been conducted on critically ill populations, mainly considering the HA-AKI cases. Limited studies were conducted on CA-AKI, especially in non-critically ill children.

A prospective cohort study in 505 non-critically ill hospitalized children (1 month to 12 years) after screening 750 children. Baseline creatinine was calculated using a computational method assuming a normal glomerular filtration rate (GFR) for age, hence all communities, as well as hospital-acquired AKI, were included. Kidney disease improving global outcome (KDIGO) criteria was used for classification and also serum cystatin -C levels were done to diagnose AKI.

Fifteen percent (15.64%) of children had AKI, of which 83.54% had CA-AKI and 16.46% had HA-AKI. Of all patients with AKI, 54.43% were exposed to nephrotoxic drugs and 53.49% (23) had received 2 or more nephrotoxic drugs, and 34.18% of patients had sepsis, 35.44% of patients had dehydration. Patients with HA-AKI had a significantly longer duration of stay (15.23±5.42 days) compared to CA-AKI patients (7.48±6.42 days) and were also exposed to nephrotoxic drugs. Cystatin C had a specificity of 88.50% and a negative predictive value of 93.80%.

Non-critically ill hospitalized children are at significant risk for AKI and need more vigilant monitoring. CA-AKI should be detected proactively because they are often underreported. Cystatin-C has good specificity and negative predictive value for diagnosing AKI.

Bartter syndrome is a rare genetic disease with 5 subtypes. In Bartter syndrome type 4, patients suffer from deafness and renal dysfunction since infancy. In this report, we introduced a 16-year-old girl with congenital deafness without any previous renal complaints referred to our center due to ankle pain.

Alkaptonuria is an exceedingly rare tyrosine metabolism disorder of autosomal recessive inheritance. Only a few instances of it have been observed in Bangladeshi children. Here, we talk about a 2-year-old boy who had dark urine and was later found to have alkaptonuria.

Potter syndrome is a lethal congenital anomaly resulting from oligohydramnios due to renal agenesis and dysfunction. Because neonates with Potter syndrome have pulmonary hypoplasia, it is incompatible with life and the neonates will expire with respiratory distress during the first hours of life. Potter syndrome is rarely accompanied by congenital heart disease. We report a case of severe Potter syndrome with pulmonary valve atresia that expired a few hours after birth.